Massive lower gastrointestinal bleeding in our department, the last 45 cases

Abstract Introduction Acute lower gastrointestinal bleeding (LGIB) tends to occur in elderly patients with complex comorbidities. At North Middlesex University Hospital (NMUH), LGIB patients are primarily managed by the surgical department. We amended local policies by integrating aspects of new guidelines published by the British Society of Gastroenterology (BSG). Method Handover documentation between November 2019 and January 2020 established patients admitted with LGIB (n = 45). Further data regarding the management of these patients was collated from clinical software and compared to standards set from BSG guidelines. Results We found NMUH to be efficient in ruling out upper GI bleeds via 24-hour OGDs and had low surgical intervention rates (0.02%). 40% of patients were transfused with an admission haemoglobin above suggested NICE thresholds, accounting for cardiovascular comorbidities. 56% of patients were discharged without a documented anticoagulation plan. Over 50% of patients did not have BSG recommended inpatient investigations. Conclusions Updated Trust guidelines aim to uphold areas that NMUH were shown to excel in, while reiterating NICE transfusion thresholds and include guidance regarding anticoagulant and antiplatelet medications. The Oakland score and shock index have been integrated into local protocols and will aid clinicians in making safe decisions in the management of LGIB patients.

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Simultaneous Gastric and Colonic Band Erosion Presenting as Lower Gastrointestinal Bleeding and Abdominal Pain

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2016.08.427 ◽

2016 ◽

Vol 12 (7) ◽

pp. S36-S37

Author(s):

Shadi Al-bahri ◽

Christopher Tufts ◽

John Paul Gonzalvo ◽

Michel Murr

Keyword(s):

Abdominal Pain ◽

Gastrointestinal Bleeding ◽

Lower Gastrointestinal Bleeding ◽

Band Erosion

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888 Challenges in The Management of Lower Gastrointestinal Bleeding in General Surgery: Developing Consistent Practice and Application of BSG Guidelines

British Journal of Surgery ◽

10.1093/bjs/znab134.587 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

A Bhojwani ◽

M Ahmed ◽

F Mahmood ◽

C Sellahewa ◽

C Desai

Keyword(s):

Risk Stratification ◽

Gastrointestinal Bleeding ◽

District Hospital ◽

Hospital Setting ◽

Lower Gastrointestinal Bleeding ◽

Shock Index ◽

Retrospective Audit ◽

Ct Angiogram ◽

Sensitive Tool ◽

The Uk

Abstract Introduction Lower gastrointestinal bleeding (LGIB) accounts for 3% of all surgical referrals in the UK, with an in-hospital mortality of 3.4%. The BSG 2019 guidelines recommend risk stratification as per Oakland scoring, inpatient lower GI endoscopy for admissions and CT-angiography for unstable patients. This study evaluates the delivery of these outcomes in a district hospital setting. Method Retrospective audit assessing all acute LGI bleed admissions from 01-07-2019 to 28-02-2020 at Russells Hall Hospital. Shock Index (SI) and Oakland score used to stratify patients into unstable, stable-major and stable-minor LGIB. Compliance with BSG standards was assessed by review of investigations and emergent patient management. Results 143 patients (Median age = 70years) evaluated, with 64 admissions having no formal risk stratification (OAKLAND-score) documented. Only 12 admissions underwent inpatient LGI endoscopy with sigmoid diverticulosis the most common pathology (39.3%). CT-angiogram was the initial investigation for 75% of patients admitted with unstable LGIB. Conclusions OAKLAND-scoring is a sensitive tool to stratify LGIB patients based on clinical parameters. Application of BSG-2019 guidelines and developing consistency in management is challenged by the lack of routine access to LGI endoscopy and tools to manage bleeding endoscopically.

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